Provider Demographics
NPI:1326015280
Name:NOLES, OMAR J JR (OD)
Entity type:Individual
Prefix:DR
First Name:OMAR
Middle Name:J
Last Name:NOLES
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10144 SW WASHINGTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4458
Mailing Address - Country:US
Mailing Address - Phone:503-639-0488
Mailing Address - Fax:
Practice Address - Street 1:10144 SW WASHINGTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4458
Practice Address - Country:US
Practice Address - Phone:503-639-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1052AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU31100Medicare UPIN
OROOOOPGDDXMedicare ID - Type Unspecified